Timing of Mental Health Service Use After a Pediatric Firearm Injury

Jennifer A. Hoffmann, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Christian D. Pulcini, Department of Emergency Medicine & Pediatrics, University of Vermont Medical Center and Children's Hospital, University of Vermont Larner College of Medicine, Burlington, Vermont.
Matt Hall, Children's Hospital Association, Lenexa, Kansas.
Heidi G. De Souza, Children's Hospital Association, Lenexa, Kansas.
Elizabeth R. Alpern, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Sofia Chaudhary, Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
Peter F. Ehrlich, Section of Pediatric Surgery, CS Mott Children's Hospital University of Michigan, Ann Arbor, Michigan.
Joel A. Fein, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Eric W. Fleegler, Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
Monika K. Goyal, Department of Pediatrics, Children's National Hospital, George Washington University, Washington, District of Columbia.
Stephen Hargarten, Department of Emergency Medicine, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin.
Kristyn N. Jeffries, Department of Pediatrics, Section of Hospital Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Bonnie T. Zima, UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.

Document Type

Journal Article

Publication Date

7-1-2023

Journal

Pediatrics

Volume

152

Issue

1

DOI

10.1542/peds.2023-061241

Abstract

OBJECTIVES: To examine how timing of the first outpatient mental health (MH) visit after a pediatric firearm injury varies by sociodemographic and clinical characteristics. METHODS: We retrospectively studied children aged 5 to 17 years with a nonfatal firearm injury from 2010 to 2018 using the IBM Watson MarketScan Medicaid database. Logistic regression estimated the odds of MH service use in the 6 months after injury, adjusted for sociodemographic and clinical characteristics. Cox proportional hazard models, stratified by previous MH service use, evaluated variation in timing of the first outpatient MH visit by sociodemographic and clinical characteristics. RESULTS: After a firearm injury, 958 of 2613 (36.7%) children used MH services within 6 months; of these, 378 of 958 (39.5%) had no previous MH service use. The adjusted odds of MH service use after injury were higher among children with previous MH service use (adjusted odds ratio, 10.41; 95% confidence interval [CI], 8.45-12.82) and among non-Hispanic white compared with non-Hispanic Black children (adjusted odds ratio, 1.29; 95% CI, 1.02-1.63). The first outpatient MH visit after injury occurred sooner among children with previous MH service use (adjusted hazard ratio, 6.32; 95% CI, 5.45-7.32). For children without previous MH service use, the first MH outpatient visit occurred sooner among children with an MH diagnosis made during the injury encounter (adjusted hazard ratio, 2.72; 95% CI, 2.04-3.65). CONCLUSIONS: More than 3 in 5 children do not receive MH services after firearm injury. Previous engagement with MH services and new detection of MH diagnoses during firearm injury encounters may facilitate timelier connection to MH services after injury.

Department

Pediatrics

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